Atrium Health Charlotte, North Carolina, United States
Background/Case Studies: A hospital electronic medical record (EMR) and Laboratory Information System (LIS) transition brought significant changes in the workflow for collecting blood bank specimens, leading to a 400% increase in mislabeled specimens in the first six months. The new electronic patient identification process within the EMR, Positive Patient Identification (PPID), eliminated the use of handwritten blood bank armbands. When PPID is not performed correctly, specimens are considered mislabeled, and the patient must be redrawn creating additional work for the laboratory technologists, nurses, and phlebotomists. The month prior to implementing initiatives for PPID compliance, the number of mislabeled specimens represented 8% of total blood bank specimens and a 650% increase above pre-transition levels. Multiple methodologies were utilized to improve labeling compliance.
Study
Design/Methods: A Transfusion Safety Officer (TSO) was hired allowing for dedicated personnel to focus on transfusion safety initiatives including PPID. Specimen collection was observed in all clinical settings. Discussions were held with collectors to assess knowledge of the process, address concerns, and understand barriers. Collaboration with Information & Analytics Services (IAS) allowed better understanding of the PPID process and developed reports to obtain accurate and timely mislabeled specimen data. IAS provided clinical decision support and added collection requirements in the EMR. Lab technologist permissions were enhanced allowing for identification of incorrectly performed steps in the PPID process. Events were entered into the hospital incident reporting system for safety and quality monitoring. Timely feedback was provided to department leaders for follow-up with collectors. Education was presented in discussions during department meetings and by distribution of a newly created tip sheet with updated workflows. Participation in various hospital committees allowed for greater PPID engagement with nursing, physician, quality, and safety leaders throughout the multi-hospital system.
Results/Findings: Significant decreases were made in the number of mislabeled specimens from peak levels of 8-9% of blood bank specimens to 2-3% in recent months (Figure A). Continued efforts are being made with the goal of meeting and exceeding pre-transition specimen labeling compliance. Conclusions: The overwhelming changes of a new EMR and LIS for a multi-hospital system can rarely achieve seamless transition. An approach of dedicated personnel, multidisciplinary collaboration, observation, education, data trending, timely feedback, and continued monitoring resulted in a significant reduction in mislabeled specimens.
Importance of research: Unexpected challenges during the transition to a new EMR and LIS can be detrimental, especially when related to blood bank specimen collection. The patient identification process when collecting blood bank specimens is highly regulated and critical to patient safety. Having a sample from the correct patient is imperative to providing a safe product. Transfusion with an incompatible blood product can result in severe and potentially fatal transfusion reactions.
